Centre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
Centre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia.
Pediatrics. 2015 Apr;135(4):e994-1001. doi: 10.1542/peds.2014-3482. Epub 2015 Mar 2.
Overdiagnosis and underdiagnosis of attention-deficit/hyperactivity disorder (ADHD) are widely debated, fueled by variations in prevalence estimates across countries, time, and broadening diagnostic criteria. We conducted a meta-analysis to: establish a benchmark pooled prevalence for ADHD; examine whether estimates have increased with publication of different editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM); and explore the effect of study features on prevalence.
Medline, PsycINFO, CINAHL, Embase, and Web of Science were searched for studies with point prevalence estimates of ADHD. We included studies of children that used the diagnostic criteria from DSM-III, DSM-III-R and DSM-IV in any language. Data were extracted on sampling procedure, sample characteristics, assessors, measures, and whether full or partial criteria were met.
The 175 eligible studies included 179 ADHD prevalence estimates with an overall pooled estimate of 7.2% (95% confidence interval: 6.7 to 7.8), and no statistically significant difference between DSM editions. In multivariable analyses, prevalence estimates for ADHD were lower when using the revised third edition of the DSM compared with the fourth edition (P = .03) and when studies were conducted in Europe compared with North America (P = .04). Few studies used population sampling with random selection. Most were from single towns or regions, thus limiting generalizability.
Our review provides a benchmark prevalence estimate for ADHD. If population estimates of ADHD diagnoses exceed our estimate, then overdiagnosis may have occurred for some children. If fewer, then underdiagnosis may have occurred.
注意力缺陷多动障碍（ADHD）的过度诊断和漏诊现象广泛存在争议，这主要是由于不同国家、不同时间以及诊断标准的不断放宽导致患病率估计值存在差异。我们进行了一项荟萃分析，旨在：建立 ADHD 的基准汇总患病率；检查不同版本的《精神障碍诊断与统计手册》（DSM）出版后，估计值是否有所增加；并探讨研究特征对患病率的影响。
我们在 Medline、PsycINFO、CINAHL、Embase 和 Web of Science 上搜索了有关 ADHD 时点患病率估计值的研究。我们纳入了使用 DSM-III、DSM-III-R 和 DSM-IV 诊断标准的任何语言的儿童研究。我们提取了关于抽样程序、样本特征、评估者、测量方法以及是否满足全部或部分标准的信息。
符合条件的 175 项研究共纳入了 179 项 ADHD 患病率估计值，总体汇总患病率为 7.2%（95%置信区间：6.7 至 7.8），不同 DSM 版本之间无统计学差异。在多变量分析中，与第四版相比，使用修订后的第三版 DSM 时 ADHD 的患病率估计值较低（P=0.03），而在欧洲进行的研究与在北美进行的研究相比（P=0.04），患病率估计值也较低。很少有研究采用随机选择的人群抽样。大多数研究来自单一城镇或地区，因此限制了其普遍性。
我们的综述提供了 ADHD 的基准患病率估计值。如果 ADHD 的人群诊断估计值超过我们的估计值，那么可能对某些儿童出现了过度诊断。如果诊断较少，则可能出现漏诊。
